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NPI Code Detail

MEDICARE: S ROBERT LEAVER

MEDICARE: S ROBERT LEAVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/CenterS3-17NV

General Provider Information

NPI Number : 1558547869
Entity Type Code : Organization
Provider Name (Legal Business Name) : S ROBERT LEAVER
Provider Business Mailing Address
First Line : 4610 MEADOWS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2965
Country : US
Telephone Number : 702-274-4566
Fax Number : 702-878-1397
Provider Business Practice Location Address
First Line : 4610 MEADOWS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2965
Country : US
Telephone Number : 702-274-4566
Fax Number : 702-878-1397
Authorized Official
Title or Position : PRESIDENT
Name : S ROBERT LEAVER III
Credential :
Telephone Number : 702-274-4566
Provider Enumeration Date : 01/16/2008
Last Update Date : 01/16/2008

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Directions to “S ROBERT LEAVER ” Practice Location

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